Intervention for disabling anxiety in older adults injured by falls The goal of this application is to establish myself as an independent investigator who develops interventions for disabling anxiety in older adults injured by falls. Each year, millions of older Americans experience a threat to life or serious injury because of a fall. Despite increasing recognition of the psychological consequences of falling, advances in knowledge of trauma have yet to be applied to this population. My four training goals will be: (1) To deepen my understanding of pre-existing factors that may complicate treatment of older patients; (2) To broaden my familiarity with the process of physical rehabilitation for older patients; (3) To strengthen my ability to integrate knowledge of psychopharmacology in the development of interventions for older patients; and (4) To acquire the skills and data needed to design studies of the efficacy of clinical interventions. The proposed program of coursework, meetings with internal and external consultants, and research will be completed under the mentorship of JoAnn Difede, Ph.D., and Martha Bruce, Ph.D., M.P.H. I will use institutional resources at Weill Cornell Medical College as well as the participation of diverse professionals, patients, and communities accessible from its New York City campuses. I will conduct research during the award period that will have three aims: (1) To adapt cognitive- behavioral exposure therapy (ET) for use with older adults with disabling anxiety-full posttraumatic stress disorder (PTSD), subsyndromal PTSD, or specific phobia (fear of falling) resulting from a fall. The ET will consist of eight sessions incorporating psychoeducation, relaxation training, cognitive restructuring, behavioral activation, and exposure. Modifications will include delivering the treatment at home and encouraging healthy behaviors (communication with healthcare professionals, strengthening social support, engaging in valued activities, and practicing falls prevention); (2) To conduct an open-treatment feasibility trial of ET with this population. Potential participants (recruited via the Division of Critical Care and Trauma) will complete a baseline assessment within three months of returning home from the hospital. Eligible participants who provide informed consent (N = 32) will receive the ET and be re-assessed upon completion of treatment and at three month follow-up. I will evaluate the a) availability of participants, b) enrollment and retention, c) acceptability of the treatment, and 4) the impact of the intervention on diagnosis, symptoms, and quality of life; (3) To conduct a randomized controlled pilot test of the ET. Eligible participants who provide informed consent (N = 64) will be randomized to either ET or a control condition (Relaxation Training) following similar procedures. This study will provide an opportunity to understand three further elements: a) the feasibility of randomization, b) feasibility of the control condition, and c) explore the primary efficacy of the ET. The proposed program will culminate in an application to fund a fully randomized controlled trial. This will be the first trial of ET for older adults with disabling anxiety resulting from a fall. PUBLIC HEALTH RELEVANCE: Although several effective treatments for posttraumatic stress and specific phobia exist, little work has been done to apply these to the needs of older adults, especially those injured by accidents such as falls. This career award will enable me to pursue a program of coursework, mentorship, and research that will allow me to make a significant contribution to this issue. During the award period, I will conduct adapt an evidence-based treatment to make it suitable for older adults with disabling anxiety as a result of being injured by a fall, test the feasibility of the treatment on approximately 96 older patient, and refine both the treatment and research approach in readiness for more intensive study of the treatment's efficacy with a larger sample of patients.